The power of discernment

I am proud to be a supporter of natural childbirth. I am thankful for the opportunities I have had to assist families as they made decisions about birth and parenting as both a childbirth educator and a doula. But I’m starting to realize something that bothers me.

The advice that I used to give as a doula and childbirth educator was not always helpful or even correct. Ouch! For someone who adores research as much as I do, that is difficult to say. But I’m realizing how unfortunately true that statement is.

Why do I say that? Because I had limited understanding of the real problems in pregnancy, and I used that understanding as the basis for all the information I gave.

As a doula and childbirth educator I was trained in natural, normal, physiological pregnancy and birth. But included in that training was an unhealthy dose of distrust of the medical establishment. I was not trained to mistrust research, I was not trained to question what was posed as “natural.” I was trained that doctors (and sometimes midwives) make terrible decisions about how to care for patients because they do not know the truth about birth.

I tried to temper this distrust by objectively educating my clients. I never told them their doctor was an idiot, but I made sure to point them to resources that countered what their doctor had to say. I believed what I had been taught, problems in pregnancy and childbirth were rare – so rare in fact that I encouraged all my clients to disbelieve any problem they might be having was really a problem.

Whether their problem was real or not is NOT the issue. What is the issue is that I lacked the ability to discern when a problem was real and when it was not. In my early days as a childbirth educator I passed on that lack of discernment – all concern about blood pressure, weight gain or issues with the baby must be false because doctors are not to be trusted and real problems are so rare. As I gained experience and expanded my knowledge I slowly began to understand that sometimes problems do exist. But I still didn’t understand how to tell the difference between something really dangerous and something just a little off.

My challenge to you is this – start developing that discernment. Learn what blood pressure means, how it relates to problems and how to tell that it is a problem. Learn about weight gain and loss in pregnancy and how they relate to problems. Learn about the most common problems, what increases the risk and how they are generally treated. Develop a knowledge about these most common problems so when clients come to you, you are able to point them to a wide variety of evidence based sources so they can learn to discern the real problems from the hype. Become familiar with recommended treatments so you can point them to resources that allow them to make treatment decisions.

Approaching potential problems in this way helps your clients become partners with their health care provider rather than fearing every suggestion is just to move them a step closer to cesarean. And if the health care provider does not practice evidence based care, it makes it very obvious for your clients to recognize it and find someone else who does.

Jennifer Vanderlaan (Author)

Comments

catalinakel
March 17, 2011 at 12:36 am

Good points. Amazingly, your writing is causing me to reconsider becoming a direct entry midwife and really looking at becoming a CNM. Which is so hard to admit. And reckon with; after all, I am fifty one and would be pretty much starting from scratch. I really don’t want to take the time to do it, and I don’t have the money. Could you talk me out of it? I want to be wise and knowledgeable and discerning. How many births did you attend as a doula?

I’m embarrassed to admit that I didn’t keep good records when I started so I don’t really know the exact number of births I attended. And I stopped counting before I stopped attending births because I stopped doing it as a “business.” In hindsight, that was a bad move and I would never recommend any other doula do that. My best guess is between 65 and 100.

There are many paths to midwifery, and while I don’t think any one path regularly produces superior midwives, I do think there will be a right path for you. But you are the only person who can find that path.

Think about your goals as a midwife. What do you want to do? What populations do you want to help? Where do you want to work? And yes, how much time and money can you invest in training?

I can tell you that I never thought I would be studying to be a CNM – I never expected to be a midwife and I certainly never wanted to be a nurse. But this is my path because of the work I have chosen to do.

I plan to work in areas with little or no access to health care – so I need to have as full understanding as possible of all health conditions and illnesses.

I plan to start midwifery schools in developing countries – so I need qualifications that every government will recognize.

I plan to do research and advocate for policy that saves the lives of mothers and babies – so I need to develop research skills beyond reading journals.

Because of this, I have chosen to study midwifery as an advanced practice nurse. This allows me to prepare to become a Family Nurse Practitioner while I am training to be a CNM. Because I know I want to work in research and policy I am also working towards an MPH. This is a dual program, so I can do both at the same time.

But that fact is, what I am doing is extreme – it is expensive in terms of time and money. My family loses time with me. I don’t have much life outside studying. My only exercise is walking to classes. I have days when I eat nothing more than oatmeal and coffee. I have days when I’m afraid I’m headed down the wrong path. I have days when I doubt I can make it through to graduation. The whole time I know, I may have to start all over for a PhD to be effective at making the changes I want to see in the world.

In short, don’t decide which program is for you based on which makes you a better midwife – CPM or CNM you really need to have the same knowledge base and both will prepare you with that. Make the decision based on which type of program will better prepare you for the work you plan to do.